Evaluation of Standards in Implant Therapy Planning Methods

Objectives: Today, oral implants are a treatment option to restore missing dentition. Successful implant-therapy requires osseointegration and optimal placement of the fixture. Final reconstruction requirements determine outcome success. Different planning protocols have been reported. More recently, computer aided planning has been introduced. Aim of the study was the analysis of the currently applied implant planning methods. Methods: 4 planning protocols were analyzed regarding treatment costs, planning time and treatment outcome. A) Control protocol included periapical and/or panoramic radiographs, diagnostic casts mounted in a semi-adjustable articulator (n=13). B) Panoramic radiographs using diagnostic template with radiographic markers (n=54). C) Fabrication of diagnostic tooth arrangement and transformation into a radiographic template. CT-scan with diagnostic template in position. Template modified to surgical stent (n=18). D) Template according to C, CT was analyzed using interactive software to determine optimal position of implants, CAD/CAM surgical guide produced prior to surgery (n=12). Results: Costs of C and D were 2 to 4X higher than those of A and B respectively, where the relationship between the final prosthesis and the bone structures was not visualized before surgery. In 35% of the latter cases there was a lack of bone where the surgical template was directing the surgeon to place the implant. C and D provided practitioners with the ability to assess the quantity and quality of bone and anatomic structures before surgery. Planning time was shorter for C and D. D enabled surgeon to transfer position of implant from planning to surgical field more precisely. Treatment outcome was best with D. Conclusion: Higher costs of C and D are reasonable as compared to the higher predictability of implant surgery. Based on this analysis, D should become the protocol of choice as it offers highest predictability.